Report of the 2009 Presidential Task Force on Psychology’s Contribution to End Homelessness

Introduction

Each year between two and three million people in the United States experience an episode of homelessness. Psychologists — clinicians, researchers, educators and advocates — must expand their efforts to end homelessness.

The 2009 Presidential Task Force on Psychology’s Contribution to End Homelessness was commissioned by James Bray, PhD, during his tenure as APA's president.

The Task Force's mission was to identify and address the psychosocial factors and conditions associated with homelessness and define the role of psychologists in ending homelessness.

The Task Force adopted an inclusive definition of homelessness. Homelessness exists when people lack safe, stable and appropriate places to live. This definition includes people living doubled up or in overcrowded living situations or motels due to inadequate economic resources as well as those living in tents or other temporary enclosures.

The episodic, transient nature of homelessness makes it difficult to ascertain accurate estimates of prevalence. HUD reported that 1.6 million people were without homes in 2008, but this number is likely to be an underestimate. In the United States, the overall population of people living without homes can be divided into several subgroups, including individual adults, families with children and unaccompanied youth who have left home, run away or "aged out" of foster care placements.

Facts on homelessness

Among those living without homes are people of all ages, races, ethnicities, cultural backgrounds, sexual orientation and immigration status. Homelessness occurs when a cascade of economic and interpersonal factors converge in the lives of people marginalized in society.

When compared with the general population, people living without homes have poorer physical health. They have higher rates of tuberculosis, hypertension, asthma, diabetes and HIV/AIDS as well as higher rates of medical hospitalizations.

Although poor people with substance abuse and/or mental illness are clearly at greater risk for becoming homeless and face additional barriers in exiting homelessness, most people without homes do not have substance use or other mental disorders.

A strong association exists between homelessness and involvement in the child welfare system. The pathway between foster care and adult homelessness is complex.

A history of incarceration is also associated with significantly higher likelihood of being homeless. And former prisoners are at increased risk for recidivism when homelessness is involved.

There is also a strong link between homelessness and hospitalization. Many argue that deinstitutionalization is directly responsible for homelessness among people with serious mental illness. However, the lack of comprehensive services, most importantly supportive housing, likely has a greater impact.

Finally, much research focuses on the negative mental health outcomes associated with homelessness. However, evidence indicates that many people without housing function quite well. By understanding protective factors, such as social support, psychologists can develop targeted prevention and intervention models.

Psychologists' role

Models that describe how people become homeless include micro- and macro-level perspectives.

Promising theoretical models that demonstrate how psychology can better address homelessness include the trauma model, the risk amplification model and the ecological model.

Remediation of homelessness

Efforts to remediate homelessness at the individual level include providing housing and supportive services. Those services include addiction treatment, mental health services, medical treatment, intensive case management, assertive community treatment, critical time intervention and ecologically based family therapy.

The report also discusses topics related to clinical relationships between psychologists and people experiencing homelessness. These include building trusting relationships, working as part of a team, assisting with welfare benefits, self-care, hands-on treatment and detecting other conditions.

Existing literature devotes considerable attention to treatment-oriented approaches for dealing with the social problem of homelessness. Psychologists, other researchers and policymakers have only recently begun to consider ways to prevent homelessness from occurring in the first place.

Recommendations

In their roles as clinicians, researchers and educators, psychologists have unique contributions to make toward the remediation of homelessness.

Research

Direct research efforts towards prevention of homelessness in marginalized and vulnerable populations.

Design and disseminate evidenced-based interventions for work with those currently experiencing homelessness.

Engage in program evaluation with a focus on mechanisms that support rapid return to permanent housing and methods for sustaining housing in vulnerable populations.

Conduct research on service utilization among chronically and pervasively mentally ill populations at risk for homelessness.

Investigate methods to promote resilience in at-risk populations, including children and youth.

Training

To enhance psychologists' ability to work effectively with populations at risk of homelessness or currently living without homes, the Task Force urges educators to:

Incorporate into graduate school curricula theoretical and applied perspectives of working with diverse and underserved populations at risk for homelessness.

Develop practicum and internship placements that allow trainees opportunities to work with at- risk populations. These include sheltered families and adults, children in foster care placements, unaccompanied youth, individuals with chronic mental illness and persons with substance and alcohol dependence.

Create continuing education programs that encourage psychologists to engage in work with populations experiencing homelessness.

Enlist psychologists to offer appropriate mental health education programs to service providers, charitable groups, community volunteers and the public. The focus of such training should include better understanding of psychosocial factors associated with entrance into and exit from homelessness. Educational program content should strive to dispel the stigma associated with homelessness and pervasive mental illness and promote strength- based approaches to working with marginalized populations.

Practice

In accordance with APA guidelines that encourage psychologists to provide clinical and other services to marginalized and under-served people, the Task Force recommends that psychologists:

Provide strength-based clinical and assessment services to populations who are homeless or at risk of homelessness. These include families involved with child welfare agencies, children in foster care placements, unaccompanied youth, persons experiencing alcohol or illegal substance dependence and persons of all ages identified with pervasive and/or chronic mental illness.

Maximize the utilization of clinical and assessment services by providing them in accessible settings and at times that reflect the needs of the populations served.

Create meaningful collaborations among psychologists, social workers, case managers, nurses, physicians, teachers and schools to best serve the multifaceted needs of individuals at risk of homelessness or those who currently are without stable housing.

Advocacy

To prevent an increase in homelessness, better address the needs of those currently without housing and promote the rapid exit from homelessness where it currently exists, the Task Force encourages psychologists to work at the state, local and federal levels to:

Advocate for legislation to provide a range of needed services, including mental health services to at-risk families, unaccompanied youth and children and adults with disabilities.

Advocate for funding for targeted counseling services, education and job training opportunities for youth in foster care and transitional services for those returning to home placement and/or communities.

Advocate for an increase in substance abuse and alcohol treatment programs, including services that promote strengthening of families.

Advocate for health-care coverage for those without homes and those at risk of losing stable or permanent housing.

Advocate for education and job training and after-school and day-care programs to support poor families.

Advocate for debt forgiveness programs for psychologists and others engaged in research on preventing or ameliorating homelessness.

Advocate on an individual basis for persons who need services, including low-income housing, supplemental income, food and benefits.